Osteopathic Approach to Obstetric Patient Flashcards
How does treating maternal somatic dysfunction impact the patient?
- enhances homeostasis
- facilitates adaptation to structural and hormonal chagnes
- alleviates discomfort
How does pregnancy effect pre existing msk conditions?
- Scoliosis:
- may develop more pain
- curves dont increase
- possible inc. pre birth
- RA
- improved sx
- Ankylosing spondylitis
- aggravated by pregnancy
What msk chagnes occur during pregnancy?
- anterior tilt of pelvics with exaggerated lordosis of low back
- flexion of upper back and lower neck
- anterior internal shoulder roattion
- ligamentoyus laxity
- weakness/separation of abdomen muscles
- increased mobility of SI joinnts and pubic symphysis
- compression of sutures due to fluid retention
decreased ROM of lumbar spine
What low back pain symptoms are red flags and need further evaluation/referral?
- Severe pain interferring with function and non positional persistent pain at night
- increased pain with cough sneezing
- neuro sx:
- bladder bowl incontinence, loss of strength, weakness, sensory deficits, abnormal reflexes
Who is at risk for LBP in pregnancy?
- Previous hx
- multiparity
- high BMI
- smoking
- age
- strenuous work
- dysmenorrhea
80-95% resolves after birth
Hemodynamic chagnes in pregnancy?
- inc. in cardiac output, blood volume, plasma volume
- decrease in systemic vascular resistance, blood pressure, hematocrit
How should pregnant women lay?
Left lateral recumbent position as laying on the right can compress the IVC leading to dec CO, SVR, and increased HR
the picture shows snake like blue/purple engorged veins on the vulva.
recommend she sleep in the left lateral recumbent position
stagnant hypoxi
What is relaxin?
- elevated during first trimester declines in second
- remains stable throughout pregnancy
- responsible for weidening and mobility of SI joints and pubic symphysis around 10-12 weeks
- women with LBP have higher levels of relaxin
How does progesterone impact pregnant women?
- Promotes fluid retention
- dec. oxygen and metabolism at cellular level
- inc metabolic waste products in soft tissues and GI tract
- changes thoracic cage configuration
- increases circumference
- subcostal angle widens
- diaphragm pushed superiorly
- increases tidal volume
Indications for OMT in ob patient?
- SD
- scoliosis or structural condition with pregnancy
- edema or congestion
Relative contraindications to OMM in OB patient?
- PROM
- premature labor
- contractions of uterus resulting in changes in cervix before 37 weeks
absolute contraindications?
- placental abruption
- placental previa
- prolapsed umbilical cord
- undiagnosed vaginal bleeding
- ectopic pregnancy
- thereatened or incomplete abortion
- severe pre-eclampsi/eclampsia
Goals of treatment in pregnant patient?
- address postural stressors
- treat SD allowing body to compensate for changes from pregnacny better
In the first trimester what should you look for in a PE?
- mechanical issues
- postural exam 3 planes
- thoracic cage and inflet fascia
- pelvis and sacrum
- CRI
With Hyperemesis gravidarum where should you treat?
- OA-C2 and T5-9
During second trimester how often are visits?
Monthly
What do you expect to find on a pregnant woman during second trimester in terms of SD?
- anterior rotated pelvis about a right/left axis
- increased pelvic tilt
- increased lumbar lordosis (extension lesions)
- Compensatory increase of thopracic kyphosis
- can cause cervical extension for compensation
- Round ligament pain(?)
- posture based contraction of the psoas muscle
How often do visits occur during third trimester?
Biweekly
What can happen during third trimester if you treat a pregnant patient supine?
Could get Hypotensive
Why should you avoid CV4 treatment during third trimester?
- it can provoke uterine contractions
What viscerosomatics should be treated or evaluated for complaints of Heart burn/GERD, Adrenal, Ovaries?
- Heartburn/GERD→ Upper GI → T5-9
- Adrenal → T10-L2
- Ovaries → T10-L2
What would treating the pelvic diaphragm potentialy help?
constipation
During the last 4 weeks of pregnancy, how often are visits?
weekly
During labor what OMT can be done?
- evaluate lumbosacral region and pelvis use soft tissue MFR
- expect dysfxn in innominates sacrum and pubic symphysis
What causes rupture of the pubic symphysis?
- fetal macrosomia
- precipitous labor/rapid 2nd stage
- intense contractions
- previous pelvic trauma
- forceps
Signs and Symptoms of ruptured pubic symphysis?
- hear audible crack, palpable gap larger than 1 cm with local tissue edema
- acute pain radiating to back/thighs
- waddling gait
- inc pain on gait or bending
Tx for rupture of pubic symphysis?
Bed rest, pelvic binder, OMM
When should the first OMM visit occur post partum
- first day post partum
- treat before resolution of relaxin hormone
- anterior sacral base due to the lithotomy position and pushinga baby (causes cranial extension)
- treat this
When should second visit post partum occur?
- 4 weeks
benefits of exercise in pregnancy? What are ACOG recommendations on how much exercise?
- 30 min or more most days of the week
- improves fitness and cardiorespiratory fxn
- enhances psychological well being
- dec risk for comorbidities due to sedentary lifestyle
- prevent or resuce severeity of MSK complains
- Reduce urinary incontinence
What exercises should be avoided in pregnancy?
- risk of falling
- contact sports
- jumping quick direction changes
- heat
- valsalva maneuver (can dec uteroplacental blood flow)
- scuba diving
- activity with high altidue
Relative contraindication to aerobic exercise?
- IUGR
- Unevaluated maternal cardiac arrhythmia
Absolute contraindications to aerobic exercise?
- incompetent cervix
- multiple gestations (triplets +)
- IUGR
- Persistent second or third trimester bleeding
- Placenta previa >28 wks
- Premature labor during current pregancny
- PROM
- Preeclampsia
